BioBus Virtual Summer Camp BioBus at Home: Summer Camp Registration Join us online for a week for virtual science activities, demonstrations, and tours! In our BioBus at Home Summer Camp, campers will meet research scientists, remotely tour their laboratories, then work with BioBus scientists to learn the tools of the science communication trade! Campers will meet virtually with BioBus Scientists and Interns and be provided with at-home activities to limit screen time. The week will culminate in a virtual celebration where students will showcase their science communication projects! To participate in this program, you will need internet and an internet-capable device from 10 am - 12 pm and 1 pm to 3 pm. If you need a device please indicate it below. Dates: Session 1: August 3 - 7 (ages 10 - 12) Session 2: August 10 - 14 (ages 12-14) Time: Virtual forums and at home activities will take place between 10 am and 3 pm Price: $500 per session **financial aid on a sliding scale basis available** Having trouble? Email danny@biobus.org Which session would you like to apply to?Please select... Session 1, August 3 - 7 (ages 10 - 12) Session 2, August 10 - 14 (ages 12-14) Your information Your First Name Your Last Name Your Email Your Phone Number Your Relationship to the StudentPlease select... Mother Father Aunt Uncle Stepmother Stepfather Extended Family Family Friend Other Other relationship Student Contact Information Student First Name Student Last Name Student Email (if applicable) Student Phone Number (if applicable) Student Background Student's Date of Birth T-Shirt SizePlease select... Extra small Small Medium Large Extra Large Student GenderPlease select... Male Female Other Student EthnicityPlease select... American Indian/Alaskan Native Asian/Pacific Islander Black Hispanic/Latino Mixed Race Other White Other Gender Description Other Ethnicity Description What school does your child currently attend? If the school does not appear as you are typing, simply enter the name of the school. Student's Household Address Street Address City State Zip Code Medical Information Does this student have any allergies?Please select... Yes No Please list any allergens. Does this student have any other condition that we should be aware of that may endanger, alter, or somehow limit his or her ability to participate in our program? Please select... Yes No Please describe the condition in detail: Photo Release Does BioBus, Inc. have permission to use this student's photograph(s), likeness and/or interview, in any form and in any media for advertising, publicity, trade or any other lawful purposes?Please select... Yes No Authorized Pick-ups Does this student have permission to leave unaccompanied at the end of the class?Please select... Yes No Would you like to add additional authorized pick-ups for your child? Note: Student will only be released to you and people listed here.Please select... Yes No Who may leave with the student? (if different than registering parent) First Name Last Name Phone number Email Relation to studentPlease select... Mother Father Grandfather Grandmother Uncle Aunt Sibling Stepmother Stepfather Family Friend Other relative Should we also try to contact this person in case of an emergency?Please select... Yes No Add another authorized pickup? Please select... Yes No Who may leave with the student? (if different than registering parent) First Name Last Name Phone number Email Relation to studentPlease select... Mother Father Grandfather Grandmother Uncle Aunt Sibling Stepmother Stepfather Family Friend Other relative Should we also try to contact this person in case of an emergency?Please select... Yes No Add another authorized pickup? Please select... Yes No Who may leave with the student? (if different than registering parent) First Name Last Name Phone number Email Relation to studentPlease select... Mother Father Grandfather Grandmother Uncle Aunt Sibling Stepmother Stepfather Family Friend Other relative Should we also try to contact this person in case of an emergency?Please select... Yes No Add another authorized pickup? Please select... Yes No Who may leave with the student? (if different than registering parent) First Name Last Name Phone number Email Relation to studentPlease select... Mother Father Grandfather Grandmother Uncle Aunt Sibling Stepmother Stepfather Family Friend Other relative Should we also try to contact this person in case of an emergency?Please select... Yes No Emergency Contact Would you like to add an emergency contact that is different than the registering parent or one of the designated contacts above?Please select... Yes No Emergency Contact Info First Name Last Name Phone number Email Relation to studentPlease select... Mother Father Grandfather Grandmother Uncle Aunt Sibling Stepmother Stepfather Family Friend Other relative Financial Aid Would you like to apply for financial aid for this class?Please select... Yes No Parents' combined income in 2019Please select... Under $20,000 $20,000-$35,000 $36,000-$50,000 $51,000-$74,000 $75,000-$100,000 Does your family income qualify you for Medicaid, SNAP, TANF, or other similar government aid? *Please select... Yes No Number of children in home Any additional information that you would like for us to know? Do you need an internet-enabled device for the camp?YesNo Contact Information
